Has the Affordable Care Act Improved Health in the United States?

The debate over the Affordable Care Act raises the question of whether increasing access to health insurance in the United States leads to better health. A recent analysis of studies from the last decade suggests that expanded access to health insurance does lead to improved health in many ways as well as a reduced risk of death, researchers from Harvard reported in the New England Journal of Medicine.

“We know far more now about the effects of health insurance than we did when the Affordable Care Act (ACA) was originally passed, due to many recent high-quality studies,” said lead author Benjamin D. Sommers, MD, PhD, in a press release. “The evidence we reviewed in this paper shows that coverage makes a major difference in people’s ability to live healthier and longer lives,” said Dr. Sommers, Associate Professor of Health Policy and Economics at Harvard Chan School, Associate Professor of Medicine at Harvard Medical School.

The researchers reviewed information from more than 40 studies on this topic, and found that increased access to health care has allowed more people to afford needed care, and allowed greater access to preventive services, primary care, treatments for chronic illnesses, medications, and surgical care. In turn, these changes have led to a wide range of improvements in overall health. More specifically, the ACA has improved rates of diagnosis and management of depression, one of the most common chronic conditions in the United States, the authors noted.

In addition, expanded access to health care saves lives, with the largest reductions in death occurring from conditions that are frequently treated with adequate medical care, such as infections, heart disease, and cancer. In contrast, policies that reduce health care coverage may “produce significant harms to health,” particularly among poorer patients and those with chronic health conditions, the researchers noted.

Dr. Sommers and his coauthors noted that some findings have shown that patients report their overall health is better once they became insured under the ACA, while other studies have not shown this benefit. This may be because of differences in study design or length, as well as the complexity of the links between insurance coverage and particular health effects.

They added that there are many unanswered questions regarding how best to improve health insurance in the United States. However, they believe that the question of whether enrollees benefit from that coverage is not one of the unanswered questions. “Insurance coverage increases access to care and improves a wide range of health outcomes,” they concluded.

Coauthors of the paper include Atul A. Gawande, MD, MPH, and Katherine Baicker, PhD. Dr. Gawande is the Samuel O. Thier Professor of Surgery at Harvard Medical School, a Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health, and a practicing surgeon at Brigham and Women’s Hospital.